HALP Score in Rheumatoid Arthritis: Association With Disease Activity

Key Takeaways

• Lower HALP values were reported in RA than in matched controls and were also seen more often in active disease than in remission.
• HALP showed inverse associations with CRP, VAS-pain, and DAS28-CRP across the RA cohort.
• The authors interpreted HALP as a supportive marker of inflammatory burden and called for prospective multicenter validation.

This analysis included 106 patients with RA and 110 healthy controls matched for age, sex, and body mass index. All RA diagnoses followed the 2010 ACR/EULAR criteria. The RA cohort was drawn from physical medicine and rehabilitation and rheumatology outpatient clinics at Antalya City Hospital during 2024. Clinical records provided demographic features, disease duration, serologic status, medication use, pain scores, and routine laboratory measures used to calculate HALP. Disease activity was classified with DAS28-CRP, and HALP showed a downward trend across remission, low, moderate, and high disease activity states.

Correlation analyses showed that HALP moved inversely with several study measures, including CRP, VAS-pain, and DAS28-CRP. The reported coefficients were -0.329 for CRP, -0.399 for VAS-pain, and -0.348 for DAS28-CRP, each reaching statistical significance. No significant correlation was reported with ESR or disease duration in the same analysis. Receiver-operating characteristic analysis assessed whether HALP distinguished active disease from remission, yielding an area under the curve of 0.708. Using a cutoff of 41.6 or lower, sensitivity was 77.1% and specificity was 63.9%, which investigators characterized as moderate discrimination within this dataset.

In multivariable logistic regression, lower HALP and older age remained independently associated with active RA after adjustment for selected covariates. The authors described HALP as a simple composite laboratory index assembled from routinely available hematologic and biochemical parameters, and emphasized it as a supportive marker of inflammatory burden rather than a definitive diagnostic measure.

The investigators noted that longitudinal behavior and response-related change were not addressed in this analysis. Because the work was single-center and retrospective, the authors called for prospective multicenter and longitudinal studies before the association is judged more firmly.